title: Safety of ultrasound contrast agents in patients with known or suspected cardiac shunts.
abstract: Contrast-enhanced ultrasound imaging is a radiation-free diagnostic tool that uses biocompatible ultrasound contrast agents (UCAs) to improve image clarity. UCAs, which do not contain dye, often salvage "technically difficult" ultrasound scans, increasing the accuracy and reliability of a front-line ultrasound diagnosis, reducing unnecessary downstream testing, lowering overall health care costs, changing therapy, and improving patient care. Two UCAs currently are approved and regulated by the US Food and Drug Administration. They have favorable safety profiles and risk/benefit ratios in adult and pediatric populations, including compromised patients with severe cardiovascular diseases. Nevertheless, these UCAs are contraindicated in patients with known or suspected right-to-left, bidirectional, or transient right-to-left cardiac shunts. These patients, who constitute 10% to 35% of the general population, typically receive no UCAs when they undergo echocardiography. If their echocardiographic images are suboptimal, they may receive inappropriate diagnosis and treatment, or they may be referred for additional diagnostic testing, including radiation-based procedures that increase their lifetime risk for cancer or procedures that use contrast agents containing dye, which may increase the risk for kidney damage. An exhaustive review of current peer-reviewed research demonstrated no scientific basis for the UCA contraindication in patients with known or suspected cardiac shunts. Initial safety concerns were based on limited rodent data and speculation related to macroaggregated albumin microspheres, a radioactive nuclear imaging agent with different physical and chemical properties and no relation to UCAs. Radioactive macroaggregated albumin is not contraindicated in adult or pediatric patients with cardiac shunts and is routinely used in these populations. In conclusion, the International Contrast Ultrasound Society Board recommends removal of the contraindication to further the public interest in safe, reliable, radiation-free diagnostic imaging options for patients with known or suspected cardiac shunts and to reduce their need for unnecessary downstream testing.
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Parker
authors.forename: Mark W
authors.initials: MW
authors.lastname: Weller
authors.forename: Linda Maiman
authors.initials: LM
authors.lastname: Feinstein
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Adams
authors.forename: Michael L
authors.initials: ML
authors.lastname: Main
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grayburn
authors.forename: David O
authors.initials: DO
authors.lastname: Cosgrove
authors.forename: Barry A
authors.initials: BA
authors.lastname: Goldberg
authors.forename: Kassa
authors.initials: K
authors.lastname: Darge
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wilson
authors.forename: Mark
authors.initials: M
authors.lastname: Monaghan
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Brian
authors.initials: B
authors.lastname: Fowlkes
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
authors.forename: Fuminari
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Maria Christina
authors.initials: MC
authors.lastname: Chammas
authors.forename: Lennard
authors.initials: L
authors.lastname: Greenbaum
authors.forename: Steven B
authors.initials: SB
authors.lastname: Feinstein
mesh_terms: D000418:Albumins / Q000009:adverse effects; D000075202:Contraindications; D003287:Contrast Media / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods*; D005466:Fluorocarbons / Q000009:adverse effects; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans
chemical_list: D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; C042852:perflutren